Provider Demographics
NPI:1487956959
Name:THOMAS J STREITZ DDS PC
Entity type:Organization
Organization Name:THOMAS J STREITZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:STREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-725-6868
Mailing Address - Street 1:1711 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6709
Mailing Address - Country:US
Mailing Address - Phone:815-725-6868
Mailing Address - Fax:815-730-7809
Practice Address - Street 1:1711 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6709
Practice Address - Country:US
Practice Address - Phone:815-725-6868
Practice Address - Fax:815-730-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190109711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty